Ligature and suture device for medical application, and ligaturing and suturing method for medical application

ABSTRACT

A ligature and suture device for medical application includes a distal end insertion portion, a needle body, a ligature tool, and an operation section. The operation section includes a housing that is provided in a base end portion of the distal end insertion portion, a puncture handle that is provided in the housing so as to be able to move freely backwards and forwards and that drives the needle body, a pressing handle that is provided in the housing so as to be able to move freely backwards and forwards and that drives a pressing member, a ligature tool operation unit that is provided in the housing so as to be able to move freely backwards and forwards and that drives a ligature sheath, and a ligature handle that is provided in the ligature tool operation unit so as to be able to move freely backwards and forwards and that drives an engaging portion.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a continuation application of U.S. patentapplication Ser. No. 11/099,304, filed Apr. 5, 2005, which claims thebenefit of U.S. Provisional Patent Application Ser. No. 60/560,188,filed Apr. 7, 2004, the contents of each of which are incorporatedherein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a ligature and suture device formedical application that is inserted into a body and performs ligaturingor suturing or the like of biomedical tissue.

2. Description of Related Art

In recent years, the treating of biomedical tissue of a body usingperoral endoscopy has increased. For example, a method of forming anartificial valve is known as a treatment for disorders such asgastroesophageal regurgitation in which the functioning of the activemuscles of the lower esophagus deteriorates and gastric acid isregurgitated into the esophagus.

Here, a device exists that forms an artificial valve by ligaturingbiomedical tissue so as to cause it to bulge out under observation usingan endoscope (see, for example, Patent Documents 1 and 2).

In the system described in Patent Document 1, two needles for piercingthe biomedical tissue are provided. A sheath that can be moved freelybackwards and forwards is inserted into each needle. Furthermore,bar-shaped T-bars are fitted internally in the vicinity of the distalend of each needle. Suture thread is fixed to these T-bars. When anartificial valve is being formed using biomedical tissue, the biomedicaltissue is suctioned and the resultant bulging biomedical tissue ispunctured by the respective needles that point inwards from the operatorside. Thereafter, the T-bars are pushed out from the needles using apusher tube and the needles are then withdrawn. The two suture threadsthat penetrate the biomedical tissue are then tied, and the knot ispushed into the body using a typical knot pusher, so that the biomedicaltissue on the operator side is ligatured.

Moreover, in Patent Document 2, a suture apparatus is disclosed that isprovided with a needle operating section that has two needle sliders, apusher slider, and a housing, and that is provided integrally via a basemember with a grip, and with a ligature tool that is providedindependently from the needle operating section.

(Patent Document 1) Japanese Unexamined Patent Application, FirstPublication No. 2003-159254

(Patent Document 2) US Patent Application, Publication No.2003/0236535A1

SUMMARY OF THE INVENTION

The present invention provides a ligature and suture device for medicalapplication, including: a distal end insertion portion that is insertedinto a body cavity and in which at least one side aperture is provided;a needle body that is provided inside the distal end insertion portion,and that houses inside itself a holding member that is attached to anend portion of a ligature member that is inserted into biomedicaltissue, and in which a pressing member that presses the holding memberis inserted so as to be able to move freely backwards and forwards, andthat is able to puncture biomedical tissue that has been made to bulgeinto the distal end insertion portion via the aperture; a ligature toolthat has a flexible ligature sheath that presses a stopper that ispenetrated by the ligature member towards the biomedical tissue, andthat, at a distal end of an operating wire that has been inserted intothe ligature sheath so as to be able to move freely backwards andforwards, is provided with an engaging portion that engages with theligature member that has been inserted into the stopper; and anoperation section that is provided at a base end side of the distal endinsertion portion, wherein the operation section is provided with: ahousing that is provided in a base end portion of the distal endinsertion portion; a puncture handle that is provided in the housing soas to be able to move freely backwards and forwards and that drives theneedle body; a pressing handle that is provided in the housing so as tobe able to move freely backwards and forwards and that drives thepressing member; a ligature tool operation unit that is provided in thehousing so as to be able to move freely backwards and forwards and thatdrives the ligature sheath; and a ligature handle that is provided inthe ligature tool operation unit so as to be able to move freelybackwards and forwards and that drives the engaging portion.

In the above ligature and suture device for medical application, theoperation section may have a linking device that links the puncturehandle with the pressing handle.

In the above ligature and suture device for medical application, theoperation section may have a linking device that links the ligature tooloperation unit with the pressing handle.

In the above ligature and suture device for medical application, theoperation section may have a linking device that links the ligature tooloperation unit with the puncture handle.

In the above ligature and suture device for medical application, theoperation section may have a linking device that links the puncturehandle with the pressing handle and the ligature tool operation unit.

The present invention further provides a ligature and suture device formedical application, including: a puncture handle that is connected viaa flexible sheath to a needle body that inserts a ligature memberthrough biomedical tissue; a pressing handle that is connected to apressing member that is inserted into the needle body in order to pressa holding member that is attached to an end portion of the ligaturemember; a ligature tool operation unit that is connected to a ligaturesheath that presses a stopper that is penetrated by the ligature member;and a housing in which are fitted the puncture handle, the pressinghandle, and the ligature tool operation unit such that each is able tomove freely backwards and forwards, wherein there is also provided: afirst linking device that moves the puncture handle and the pressinghandle forward interconnectedly from an initial position where thepuncture handle is moved back as far as possible to a tissue punctureposition where the puncture handle has moved forward as far as possibleand has punctured the biomedical tissue, and releases the link betweenthe puncture handle and the pressing handle at the tissue punctureposition; and a second linking device that engages the ligature tooloperation unit with the pressing handle until the tissue punctureposition is reached, and moves the ligature tool operation unit forwardin conjunction with the pressing handle.

In the above ligature and suture device for medical application, thesecond linking device may push the pressing handle forward beyond thetissue puncture state, and the ligature tool operation unit may be movedforward interconnectedly with the pressing handle until the holdingmember is pushed out from the needle body.

In the above ligature and suture device for medical application, thesecond linking device may be a device that moves the pressing handle andthe ligature tool operation unit forwards and backwards independentlyrelative to the direction in which the pressing handle moves backwards.

The present invention further provides a ligaturing and suturing methodfor medical application in which, when biomedical tissue is ligaturedusing a stopper and a holding member, which are attached to a ligaturemember, by inserting the ligature member into the biomedical tissue bypuncturing the biomedical tissue with a needle body so as to sandwichthe biomedical tissue. The method includes: a step in which the needlebody that houses the holding member is moved forward towards thebiomedical tissue; a step in which, during the time until the needlebody penetrates the biomedical tissue, the stopper is moved forwardtowards the biomedical tissue in conjunction with the needle body; astep in which, after the needle body has penetrated the biomedicaltissue, a pressing member that is inserted in the needle body is movedforward so as to push out the holding member that is housed in theneedle body; and a step in which, after the needle body has beenwithdrawn from the biomedical tissue, the ligature member that isinserted in the stopper is pulled so that the biomedical tissue issandwiched by the stopper and the holding member and is ligatured.

In the above ligature and suture method for medical application, theremay be provided a step in which, after the needle body has punctured thebiomedical tissue, the stopper is moved forward in conjunction with theforward movement of the pressing member.

In the above ligature and suture method for medical application, theremay be provided a step in which, when the needle body is being removedfrom the biomedical tissue, the needle body is moved backward inconjunction with the backward movement of the pressing member.

In the above ligature and suture method for medical application, whenthe needle body is being removed from the biomedical tissue, the needlebody may be moved backwards independently from the stopper.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic view showing the structure of a ligature andsuture device for medical application according to a first embodiment ofthe present invention.

FIG. 2 is a top view of an operation section side of a ligature andsuture device for medical application.

FIG. 3 is a cross-sectional view showing the structure of a punctureneedle.

FIG. 4 is a cross-sectional view taken along a line IV-IV in FIG. 3.

FIG. 5 is a top view showing the structure of a ligature tool.

FIG. 6 is a partial cross-sectional view showing a distal end portion ofthe ligature tool.

FIG. 7 is a view showing the layout of the distal end portion of theligature tool and a cutter portion.

FIG. 8 is a prospective view showing the layout of the cutter portion.

FIG. 9 is a side cross-sectional view showing the structure of ahousing.

FIG. 10 is a top view of the housing.

FIG. 11 is a perspective view showing the cross-section of a tube.

FIG. 12A is a cross-sectional view showing an overtube in a state inwhich a distal end tube is connected to a tube main body, and FIG. 12Bis a cross-sectional view showing the overtube in a state in which thedistal end tube is separated from the tube main body.

FIG. 13 is a perspective view showing a state in which the distal endtube is separated from the tube main body.

FIG. 14 is a view for showing an operation when a puncture needle isinserted.

FIG. 15 is a perspective view showing a position in an initial state ofthe ligature tool.

FIG. 16 is a perspective view showing a state in which the ligature toolis moved further forward.

FIG. 17 is a view showing the operation of a ligature and suture devicefor medical application, and is a view showing the layout in an initialstate.

FIG. 18 is a view showing the operation when a pressing handle is movedforward.

FIG. 19 is a view showing a state in which the pressing handle and theligature tool move together.

FIG. 20 is a side view showing a state in which a connection between thepressing handle and a puncture handle is broken.

FIG. 21 is a view showing a state when the pressing handle is movedforward to its maximum.

FIG. 22 is a view showing a state when the pressing handle is pulledback.

FIG. 23 is a view showing an operation during ligaturing.

FIG. 24 is a view showing an operation of a cutter.

FIG. 25 is a view showing a state in which a ligature thread is cut bythe cutter

FIG. 26 a schematic view showing ligatured biomedical tissue.

FIG. 27 a side view showing a state in which the distal end tube isseparated from the tube main body.

FIG. 28 is a perspective view showing a state in which the distal endtube is separated from the tube main body.

FIG. 29 is a perspective view showing a state in which the distal endtube is that it onto the tube main body.

FIG. 30 is a view showing an operation of a ligature and suture devicefor medical application according to a second embodiment of the presentinvention, and is a side view showing the layout in an initial state.

FIG. 31 is an enlarged view showing principal portions of a ligature.

FIG. 32 is an in view showing a state in which the ligature tool ismoved forward.

FIG. 33 is a view showing an operation to make a ligature after thepressing handle has been moved backwards.

FIG. 34 is a view showing an operation of a ligature and suture devicefor medical application according to a third embodiment of the presentinvention, and is a side view showing the layout in an initial state.

FIG. 35 is a view showing a state in which the pressing handle is movedforward and the connection between the pressing handle and the puncturehandle is broken.

FIG. 36 is a view showing a state in which the pressing handle is movedforward to its maximum.

FIG. 37 is a view showing an operation of a ligature and suture devicefor medical application according to a fourth embodiment of the presentinvention, and is a side view showing the layout in an initial state.

FIG. 38 is a top view of a base end side of the operation section.

FIG. 39 is a side view showing a state in which the pressing handle isconnected to the ligature tool.

FIG. 40 is a plan view showing a state in which the pressing handle isconnected to the ligature tool.

FIG. 41 is a view showing a state in which the ligature tool is movedforward.

FIG. 42 is a view showing an operation of a ligature and suture devicefor medical application according to a fifth embodiment of the presentinvention, and is a side view showing the layout in an initial state.

FIG. 43 is a view showing a state in which only the needle bodies aremoved forward.

FIG. 44 is a view showing a state in which only the pushers are movedforward.

FIG. 45 is a view showing an operation of a ligature and suture devicefor medical application according to a sixth embodiment of the presentinvention, and is a side view showing the layout in an initial state.

FIG. 46 is a view for showing a state in which the pressing handle, thepuncture handle, and the ligature tool move together.

FIG. 47 is a view showing a state in which the pressing handle is movedforward to its maximum.

FIG. 48 is a view showing a state in which only the ligature tool ismoved forward.

FIG. 49 is a view showing a state in which only the needle bodies aremoved forward.

FIG. 50 is a view showing a state in which only the pushers are movedforward.

FIG. 51 is a view showing the layout when the ligature thread is cut byforceps of an endoscope in another embodiment of the present invention.

FIG. 52 is a view showing a state in which the ligature thread is cut bythe forceps of the endoscope.

FIG. 53 is a side view showing the structure of an operation section.

FIG. 54 is a side view showing the structure of an operation section.

FIG. 55 is a perspective view of a distal end portion of an overtube.

FIG. 56 is a perspective view of the distal end portion of the overtube,and shows the state shown in FIG. 50 rotated 180 degrees.

FIG. 57 is a view showing a positioning operation of a ligature andsuture device for medical application.

DETAILED DESCRIPTION OF THE INVENTION

Embodiments for implementing the present invention will now be describedin detail with reference made to the drawings.

First Embodiment

A first embodiment of the present invention will be described withreference to FIGS. 1 to 29. As shown in FIGS. 1 and 2, a ligature andsuture apparatus for medical application 1 according to the presentembodiment is provided with an operating section 2 that is operated by adoctor, and a flexible tube 4 is mounted on the distal end of a housing3 of this operating section 2. An endoscope insertion portion 5 is fixedto a distal end of the tube 4, and an endoscope 6 is inserted from here.A flexible overtube 7, which is a distal end insertion portion that isinserted into a body cavity, is mounted on a distal end of the endoscopeinsertion portion 5. In addition, an insertion portion 11 of a treatmenttool in the form of a puncture needle 10, such as that shown in FIG. 3and FIG. 4, and an insertion portion 42 of a ligature tool 40, such asthat shown in FIG. 6, are inserted from the housing 3 side into theovertube 7.

As shown in FIG. 3 and FIG. 4, the insertion portion 11 of the punctureneedle 10 has a flexible inner sheath 12, and a pushing member in theform of a pusher 13 that is inserted so as to be able to move freelybackwards and forwards inside the inner sheath 12. A needle body 14 isfixed to a distal end of the inner sheath 12. The needle body 14 has acircular cylinder configuration, and a distal end aperture portion 15thereof is cut so as to be diagonally inclined. As shown in FIG. 3, aslit 16 is provided extending in the longitudinal direction from aperipheral portion of the distal end aperture portion 15. Note that aholding member 17 is housed in the needle body 14. The holding member 17is attached to an end portion of a ligature thread (i.e., a ligaturemember) 18, and is known as a T-bar. The ligature thread 18 is pulled tothe outside of the needle body 14 via the slit 16. The pusher 13 isinserted into the inner sheath 12 in order to push the holding member 17and the ligature thread 18 out from inside the needle body 14. Note thatthe puncture needle 10 is provided with two inner sheaths 12 and twoneedle bodies 14 arranged in parallel with each other.

This insertion portion 11, which is provided with two pushers 13 and twoinner sheaths 12, is connected to a puncture needle operation unit 19for the puncture needle 10. The puncture needle operation unit 19 has apuncture handle 20 to which the inner sheaths 12 are fixed. The puncturehandle 20 has a substantially circular cylinder configuration, and, asshown in FIG. 3, a groove 21 is formed on an outer circumferentialsurface thereof extending in the longitudinal direction thereof from adistal end portion of the puncture handle 20 to a base end portionthereof. Furthermore, the base end portion of the puncture handle 20 isformed so as to be enlarged on the outer side in the radial direction,such that it can be easily gripped by a doctor. A linking pin 23, whichforms a first linking device, is inserted into this enlarged diameterportion 22. The linking pin 23 passes through the center of the enlargeddiameter portion 22, and a base portion 23 a thereof is urged to theupper side (i.e., upwards) as seen in FIG. 3 by an elastic member 24such as a coil spring. A distal end portion 23 b of the linking pin 23protrudes partially from the enlarged diameter portion 22. Anintermediate portion 23 c is formed between the base portion 23 a andthe distal end portion 23 b of the linking pin 23, and the diameter ofthe intermediate portion 23 c is smaller than that of the base portion23 a.

Furthermore, a slide hole 25 is provided in the puncture handle 20extending from the base end surface thereof towards the distal endportion. The slide hole 25 communicates with two through holes 26 thatare provided in the distal end portion of the puncture handle 20. Thetwo through holes 26 are provided in parallel with each other, and thediameters of each of these are large enough so that the two pushers 13can each be inserted therein and moved freely backwards and forwards. Inaddition, slits 27 are provided in parallel with the longitudinaldirection of the puncture handle 20 in an outer portion of the puncturehandle 20 so as to be connected to the slide hole 25. Two of these slits27 are provided at positions whose phases are 180 degrees apart fromeach other. Note that the two slits 27 are provided along a plane thatis orthogonal to the linking pin 23.

A pressing handle 30 is inserted into the slide hole 25 of the puncturehandle 20 so as to be able to move backwards and forwards. The pressinghandle 30 has a slide portion 31, which has a substantially columnarconfiguration, and a handle body 32 is fixed to a base end of the slideportion 31.

The slide portion 31 has an outer diameter that enables it to slidefreely inside the slide hole 25, and a guide member 33 is fixed to adistal end of the slide portion 31. The guide member 33 slides insidethe slits 27 of the puncture handle 20, and the two pushers 13 are fixedin parallel with each other to the distal end of the guide member 33.Furthermore, a slit 34 is provided in the slide portion 31 in parallelwith the longitudinal direction thereof. The slit 34 penetrates theslide portion 31 vertically, and the intermediate portion 23 c of thelinking pin 23 is inserted into the slit 34. The width of the slit 34 isnarrower than that of the base portion 23 a of the linking pin 23.However, a notch is made in a bottom side of the distal end portion ofthe slit 34 so that a portion thereof can be engaged with the baseportion 23 a of the linking pin 23.

The handle body 32 has a larger diameter than that of the slide portion31, and a linking member 35 is fixed to top portion of the handle body32. A contact surface 36 is provided in the linking member 35 (whichforms a second connecting device) that makes contact with a finger pieceportion 52 of the ligature tool 40 (described below) so as to engagewith the finger piece portion 52.

As shown in FIG. 5, the ligature tool 40 has a ligature tool operationunit 41 (a ligature portion), and a flexible insertion portion 42 isprovided in a distal end of the ligature tool operation unit 41. In theinsertion portion 42, an operating wire 44 is inserted inside theligature sheath 43 so as to be able to move freely backwards andforwards. An engaging portion in the form of a hook 45 that can beengaged with the ligature thread 18 is attached to a distal end of theoperating wire 44. As shown in FIG. 6, a stopper 47 is placed at adistal end of the ligature sheath 43 sandwiching a cutter receivingportion 46.

As shown in FIG. 5, the ligature tool operation unit 41 has asubstantially columnar shaped main body portion 50. A base end of theligature sheath 43 is fixed to a distal end portion of the main bodyportion 50. Furthermore, a knob portion 51 is fixed to the distal endportion of the main body portion 50. The knob portion 51 is the portionthat is gripped by a doctor when the doctor operates a ligature handle55 (described below). The finger piece portion 52 is attached to a baseend of the main body portion 50. A base end of this finger piece portion52 forms a flat surface 53, and this flat surface 53 comes into contactwith the contact surface 36 of the linking member 35. Furthermore, aslit 54 is provided in the main body portion 50 in parallel with thelongitudinal direction of the main body portion 50. The slit 54vertically penetrates the main body portion 50, and the ligature handle55 is attached here so as to be able to slide freely. The base endportion of the operating wire 44, which is inserted into the main bodyportion 50 so as to be able to move freely backwards and forwards, isfixed to the ligature handle 55.

The cutter receiving portion 46 shown in FIG. 6 is a circularcylindrical member whose base end portion is in contact with theligature sheath 43. Through holes 56 are provided in a side wall portionof the cutter receiving portion 46. Two through holes 56 are arranged inthe longitudinal direction of the cutter receiving portion 46 as seen inside view, and two through holes are also provided in the same manner atpositions whose phases are 180 degrees apart to give a total of fourthrough holes 56. The ligature thread 18 that has been pulled outthrough the stopper 47 is inserted into the cutter receiving portion 46.The ligature thread 18 is inserted from inside an aperture in the distalend portion of the cutter receiving portion 46 and runs through thethrough holes 56 on the distal end side towards the outside. Afterpassing along the outer circumferential surface of the cutter receivingportion 46, the ligature thread 18 is inserted through the through holes56 on the base end side running towards the inside, and is introducedinto the ligature sheath 43 from an aperture on the base end side.

The stopper 47 is manufactured from silicon resin or the like, and anintermediate portion of the ligature thread 18, both end portions ofwhich are attached to the holding member 17, is inserted into thestopper 47. The stopper 47 uses friction to engage with the ligaturethread 18, and is used to ligature biomedical tissue together with theholding member 17 (see FIG. 3).

Here, as shown in FIG. 1 and FIG. 7, in the present embodiment, a cutter60 that cuts the ligature thread 18 inside a body cavity is externallymounted on the ligature tool 40. The cutter 60 has a flexible cuttersheath 61 that covers an outer circumference of the ligature sheath 43such that the ligature sheath 43 can move freely backwards and forwards.The position of the distal end of the cutter sheath 61 matches theposition of the distal end of the ligature sheath 43. A cutter portion62 is fixed to the distal end of this cutter sheath 61.

The cutter portion 62 covers an outer circumferential surface of thebase end side of the cutter receiving portion 46, and the inner diameterof the cutter portion 62 is substantially equal to the outer diameter ofthe cutter receiving portion 46. As shown in FIG. 8, two notches 63 areprovided at positions whose phases are 180 degrees apart in the cutterportion 62. Each notch 63 has a base end at an aperture 62 a of thedistal end portion. Each notch 63 extends from there in the longitudinaldirection of the cutter portion 63, and turns in a circumferentialdirection in the vicinity of substantially the middle in thislongitudinal direction. The notches 63 then extend in thiscircumferential direction, and then turn back towards an edge portion ofthe aperture 62 a. A blade portion 65 is formed at this turning back endportion. As shown in FIG. 7, in an initial state, the cutter portion 62is placed at a position where the end portion of the notches 63 connectto the through holes 56 on the base end side of the cutter receivingportion 46. Of that portion of the ligature thread 18 that is insertedinto the cutter portion 46, the portion thereof that passes along theouter circumferential surface of the cutter receiving portion 46 isguided around so as to catch on a shoulder portion 66 that is formed bythe notches 63. Namely, the ligature thread 18 is pulled out from thethrough holes 56 on the distal end side of the cutter receiving portion46, passes along the outer circumferential surface of the shoulderportion 66 of the cutter portion 62, passes through the through holes 56from the end portions of the notches 63, and is inserted into the cutterreceiving portion 46.

In addition, as shown in FIG. 1, the base end of the cutter sheath 61 isfixed to a cutter handle 68 that is attached to a top portion (i.e., onthe upper side in FIG. 1) of the housing 3 so as to be able to movefreely backwards and forwards.

Next, a description will be given of the housing 3 in which the punctureneedle operation unit 19 and the ligature tool operation unit 41 areinstalled.

As shown in FIG. 9, a housing portion 70 into which the puncture needleoperation unit 19 can be inserted so as to be able to move freelybackwards and forwards is provided on a base end side of and below thehousing 3. The housing portion 70 is formed substantially as arectangular parallelepiped, and a substantially columnar insertion hole71 is formed in the interior thereof. A tapered surface 71 a is formedat a base end portion of the insertion hole 71 so as to increase thediameter thereof. The puncture handle 20 (see FIG. 3) is inserted intothe insertion hole 71. Through holes 72 that connect the insertion hole71 with the distal end surface of the housing portion 70 are formed inthe distal end portion of the housing portion 70. Two through holes 72are formed in parallel, and an inner sheath 12 is inserted in eachthrough hole 72 so as to be able to move freely backwards and forwards.Lighting windows 74 are formed in each side wall portion 73 of thehousing portion 70. An engaging screw 76 screws into a base end side ofa bottom portion 75 of the housing portion 70. Furthermore, a grip 77 isattached to the bottom portion 75 of the housing portion 70. The grip 77extends diagonally forwards (i.e., towards the distal end side and alsothe lower side of the housing 3) from the housing portion 70.

A slide receiving portion 78 is provided above the housing portion 70 inthe housing 3. The slide receiving portion 78 extends towards the distalend side beyond the housing portion 70. As shown in FIG. 9 and FIG. 10,the slide receiving portion 78 is formed having a substantially C shapedcross-section so that a top portion thereof forms open ends 79. Inaddition, a notch is cut in the vicinity of the open ends 79 in a baseend side of the slide receiving portion 78. As a result of this notch80, colliding portions 81 are formed in which the distance between theopen ends 79 gradually increases.

As shown in FIG. 9, a housing distal end portion 82 is provided at adistal end of the slide receiving portion 78. An outer sheath 83 and twoouter sheaths 84 that are arranged in parallel with each other areinserted into the housing distal end portion 82. The outer sheath 83 isfixed to the housing distal end portion 82 such that an aperture at abase end of the outer sheath 83 is continuous with the slide receivingportion 78. The two outer sheaths 84 are drawn out below the housingdistal end portion 82, and are each fixed so as to cover the respectivethrough holes 72 of the housing portion 70.

As shown in FIG. 11, each of the outer sheaths 83 and 84 is insertedinto a tube 4 that is fixed to the distal end of the housing 3, and isguided into the overtube 7 shown in FIG. 1. The overtube 7 has asubstantially circular cylinder shaped tube main body 90 and a distalend tube 91 that can be freely attached to and removed from a distal endof the tube main body 90. A distal end of the circular cylinder portionof the distal end tube 91 is closed off in a dome shape to form a domeportion 93. Slits 94 are provided in the dome portion 93, so that thedome portion 93 is split into a plurality of valve elements. Anelongated hole is formed running in the circumferential direction in acircular cylinder portion 92, and this elongated hole forms a sideaperture and 95 where biomedical tissue is suctioned.

As shown in FIGS. 12A, 12B, and 13, an engaging portion 96 is providedat a base end of the circular cylinder portion 92. In the engagingportion 96, a thread is cut in an outer circumferential surface of atoroidal member. In addition, as shown in FIG. 13, two positioning pins97 extend in parallel with the axial direction from the engaging portion96.

Distal end portions of each of the outer sheaths 83 and 84 are tightlybound using thread 98 to an inner wall of the tube main body 90 on thebase end side thereof at a predetermined distance from a distal endaperture 90 a of the tube main body 90. The position of the distal endportions of each of the sheaths 83 and 84 is a position where anoperation of the puncture needle 10 and ligature tool 40 (describedbelow) is not obstructed, and the thread 98 is used as a fixing devicebecause it is difficult to apply an adhesive agent coating at a positionsuch as this.

A receiving portion 99 that engages with the pins 97 is provided in aconcave configuration in the distal end aperture 90 a of the tube mainbody 90. Furthermore, a toroidal groove 100 is formed in an outercircumference in the vicinity of the distal end aperture 90 a, and atoroidal projection 102 of a toroidal ring of 101 fits here into thegroove 100. The rotating ring 101 is rotatably attached so as to coverthe outer circumference of the tube main body 90. A distal end portionof the rotating ring 101 protrudes beyond the tube main body 90, and athread is cut into an inner circumferential surface of this protrudingportion. This thread is able to be engaged with the thread on theengaging portion 96 on the distal end tube 91 side.

An operation of the present embodiment will now be described.

As shown in FIG. 14, in order to attach the puncture needle 10, each ofthe needle bodies 14 is inserted respectively into the two through holes72 of the housing portion 70 of the housing 3. The needle bodies 14 arepositioned in the through holes 72 using light that is guided into thehousing portion 70 from the lighting window 74 that is formed in theside wall portion 73.

Once the needle bodies 14 have been inserted into the housing portion70, the inner sheaths 12 are moved forward so that the respective needlebodies 14 and inner sheaths 12 are moved from the housing portion 70into the respective outer sheaths 84. The puncture needle operation unit19 is also inserted into the housing portion 70. At this time, thepuncture needle operation unit 19 is inserted such that the groove 21 inthe puncture handle 20 matches the threaded hole of the engaging screw76 of the housing portion 70. Once the puncture needle operation unit 19has been inserted, the engaging screw 76 is screwed in so that thedistal end thereof is made to protrude into the groove 21. As a result,the puncture handle 20 is able to move forwards or backwoods relative tothe housing 3 between the base end and the distal end of the groove 21,while at the same time the removal of the puncture handle 20 isprevented. At this time, the two needle bodies 14 protrude from theouter sheaths 84 inside the overtube 7 (see FIG. 1), and are placed in afirst position in the vicinity of the side aperture 95.

When fitting the ligature tool 40, after the insertion portion 42 hasbeen inserted into the cutter sheath 61, the entire cutter sheath 61 isinserted into the outer sheath 83. Furthermore, the cutter handle 68 andthe main body portion 50 of the ligature tool operation unit 41 areinserted into the slide receiving portion 78 of the housing 3. Theligature tool 40 is able to be moved forwards and backwards from aninitial position shown in FIG. 2 and FIG. 15 to an advance position suchas that shown in FIG. 16. This advance position is a position where thecolliding portion 81 comes into contact with the finger piece portion52.

Note that, as shown in FIG. 17, if the puncture needle 10 and ligaturetool 40 as well as the cutter 60 are installed, the positions of eachportion at this time become the initial positions (corresponding to thefirst position). The distal end of the insertion portion 42 is placedinside the overtube 7 a predetermined distance on the base end sidebeyond the respective needle bodies 14.

When the two holding members 17, to which are attached the ligaturethreads 18, are fitted to each of the needle bodies 14, as shown in FIG.13, the distal end tube 91 of the overtube 7 is removed. At this time,the distal end tube 91 and the tube main body 90 are held while therotating ring 101 is rotated. Once the distal end tube 91 has beenremoved, the holding members 17 are each inserted via the apertures ineach needle body 14, and the ligature threads 18 are drawn out from theslits 16 (see FIG. 3) in the needle bodies 14.

Furthermore, as shown in FIG. 6, when fitting the stopper 47 and thecutter receiving portion 46 in the ligature tool 40, the ligature handle55 shown in FIG. 5 is made to advance towards the distal end side sothat the hook 45 is exposed from the ligature sheath 43. As shown inFIG. 6, the ligature thread 18, which has been formed into a loop by thestopper 47 and the cutter receiving portion 46, is then hooked onto thehook 45, and the manipulation of the ligature handle 55 is ended.Because a spring (not shown) has been inserted between the ligaturehandle 55 and the knob portion 51, the ligature handle 55 automaticallyreturns to its initial position, and the hook 45 together with theligature thread 18 that is hooked onto the hook 45 are pulled inside theligature sheath 43. As a result, the cutter receiving portion 46 and thestopper 47 are held in this sequence at the distal end of the ligaturesheath 43.

When ligaturing biomedical tissue, the endoscope 6 is inserted from theendoscope insertion portion 5 shown in FIG. 1, and the overtube 7 isinserted into a body cavity. When the side aperture 95 of the overtube 7has arrived at the position of the ligature object (i.e., at the targetposition), a suction device (not shown) of the endoscope 6 is operated,and the target position is suctioned inside the overtube 7 via the sideaperture 95. As a result, as shown in FIG. 18, biomedical tissue W1 issuctioned inside the overtube 7.

Once the biomedical tissue W1 has been suctioned, an operator pushes inthe pressing handle 30 towards the distal end side so as to make therespective needle bodies 14 advance towards the biomedical tissue W1. Atthis time because the pressing handle 30 and the puncture handle 20 arelinked by the linking pin 23, the puncture handle 20 moves forward inconjunction with the pressing handle 30, so that, as a result, eachinner sheath 12 and each pusher 13 moves forward simultaneously. Notethat, in FIG. 18, because the ligature tool 40 is not operated, thestopper 46 is not moved forward.

If the pressing handle 30 is pushed in further, then as shown in FIG.19, the linking member 35 of the pressing handle 30 comes into contactwith the finger piece portion 52 of the ligature tool operation unit 41and engages therewith. As a result, the pressing handle 30 is engagedwith the ligature tool operation unit 41, so that if the pressing handle30 is made to move forward, the ligature tool 40 and the puncture handle20 also move forward in conjunction with the pressing handle 30 and thedistance between the holding member 17 and the stopper 47 is keptsubstantially constant.

As shown in FIG. 20, when the needle bodies 14 reach the position ofpenetrating the biomedical tissue W1 (i.e., a second position), almostall of the puncture handle 20 is inside the housing portion 70. At thistime, the linking pin 23 is buried inside the puncture handle 20 due tothe tapered surface 71 a of the insertion hole 71. As a result, the linkbetween the pressing handle 30 and the puncture handle 20 is released.Note that the operation up to this point is the same when the puncturehandle 20 is made to move forward instead of the pressing handle 30.

If the pressing handle 30 is pushed in even after the respective needlebodies 14 have arrived at the second position, then because the puncturehandle 20 remains stopped due to the link having been released, thepushers 13 move forward relative to the needle bodies 14. As a result,as shown in FIG. 21 the respective holding members 17 inside therespective needle bodies 14 are pushed out, and are discharged on theside of one side portion of the biomedical tissue W1. In addition,because the state of connection with the ligature tool 40 is maintained,the ligature tool 40 moves forward in connection with the pressinghandle 30, and the stopper 46 approaches the other side portion of thebiomedical tissue W1. Note that the positions of the pressing handle 30and pushers 13 and of the ligature tool 40 at this time are taken as athird position.

Once each of the holding members 17 has been pushed out from the needlebodies 14, the pressing handle 30 is pulled back. As it moves in thebackwards direction, because the engagement between the linking member35 and the finger piece portion 52 is released, only the pressing handle30 is pulled backwards and the pushers 13 remain housed inside theneedle bodies 14.

When the pressing handle 30 has been pulled back a predetermined amount,a distal end of the slit 34 (see FIG. 4) engages with the linking pin23, and the puncture handle 20 becomes caught by the pressing handle 30so as to begin to move backwards. At this time, the linking pin 23 thathas been pushed by the tapered surface 71 a gradually comes out so thatthe pressing handle 30 and the puncture handle 20 are linked together.As a result, the puncture handle 20 is pulled back in conjunction withthe pressing handle 30, and the pushers 13 and needle bodies 14 movebackwards simultaneously. As shown in FIG. 22, if the pressing handle 30is then pulled back to its initial position, then the puncture handle 20is also pulled back to its initial position and during this therespective needle bodies 14 are pulled out from the biomedical tissueW1. The holding member 17 is left at one side portion of the biomedicaltissue W1, and the ligature thread 18 is inserted so as to penetrateboth side portions of the biomedical tissue W1.

Next, the ligature tool shown in FIG. 5 is operated, and the biomedicaltissue W1 is ligatured by the holding member 17 and the stopper 46.Firstly, the ligature handle 55 is pulled back along the slit 54. Theoperating wire 44 that is fixed to the ligature handle 55 movesbackwards and the hook 45 pulls the ligature thread 18. As a result, asshown in FIG. 23, the holding member 17 that is attached to an endportion of the ligature wire 18 is drawn towards the stopper 47 side,and is pressed against one side portion of the biomedical tissue W1.Because the position of the stopper 47 does not move, it is sandwichedby the holding member 17 and the stopper 46 so that the biomedicaltissue W1 is ligatured.

When the biomedical tissue W1 has been ligatured, excess ligature thread18 is cut. Namely, the cutter handle 68 shown in FIG. 24 is pulled sothat the cutter sheath 61 is moved backwards. The cutter portion 62 ismoved backwards and the blade portion 65 is moved so as to cover thethrough holes 56 so that, as shown in FIG. 25, the ligature thread 18 iscut.

Thereafter, once the suction by the endoscope 6 has stopped, theovertube 7 is pulled out from the body cavity and the treatment isended. As shown in FIG. 26, the biomedical tissue W1 is ligatured by twoholding members 17 and the stopper 47 and a bulging state thereof ismaintained.

According to this embodiment, because there are provided a punctureneedle 10 that punctures the biomedical tissue W1, and a ligature tool40 that ligatures the biomedical tissue W1 that has been penetrated byligature thread 18, and because the ligature tool operation unit 41having the respective handles 20, 30, and 55 is provided integrally, anoperation can be performed by a single operator. In particular, becausethe puncture needle 10 and ligature tool 40 move in conjunction witheach other, the operation is simplified. Furthermore, when the punctureneedle 10 is made to puncture, because the respective needle bodies 14and pushers 13 as well as the ligature tool 40 are linked together,there is no pulling out of the ligature thread 18, and it is possible toinsert the ligature thread 18 reliably into the biomedical tissue W1.

Moreover, because the pressing handle 30 and the puncture handle 20 arelinked by the linking pin 23, which forms a first linking device,between the first position and the second position, so that if one ofthe handle 20 and the handle 30 is moved backwards or forwards then theother of the handle 20 and the handle 30 is also moved backwards orforwards in the same direction, and because this link is released at thesecond position, the advancing of the puncture needle 10 and thesubsequent pushing out of the holding member 17 can be performed using asimple structure in a single operation.

Furthermore, when the pressing handle 20 is moved forwards, because thelinking member 35, which forms a second linking device, is engaged withthe ligature tool 40 between the first position and the second position,it is possible to link the ligature tool 40 using a simple structure.Accordingly, simply by operating the pressing handle 30 it is possibleto perform an operation to move the ligature tool 40 forwards orbackwards. This interconnected operation continues until the pressinghandle 30 arrives at the third position. Note that the linking member 35also has a role of preventing the ligature tool 40 from coming out ofthe slide receiving portion 78.

By using the engaging screw 76, a structure can be formed in which thepuncture needle operation unit 19 is freely removable from the housing3. In addition, by using the engaging screw 76 the amount of movement ofthe puncture needle operation unit 19 can be controlled and theoperation unit 19 can be prevented from coming out or rotating.Therefore, handling of the puncture needle operation unit 19 issimplified.

Because the colliding portion 81 is formed by a notch provided in theslide receiving portion 78, and because this colliding portion 81 actsas a stopper in the forward movement direction of the ligature tool 40,it is possible to control the forward movement of the ligature tool 40using a simple structure.

Because the grip 77 of the housing 3 is inclined diagonally forwards, itis easy to apply force when moving each of the handles 20, 30, 55, and68 as well as the ligature tool 40 forwards.

Because the pins 97 are provided in the distal end tube 91 of theovertube 7, it is possible to connect the distal end tube 91 such thatthe side aperture 95 and the needle bodies 14 are always in a fixedorientation.

In addition, if treatment is conducted using this type of ligature andsuture device for medical application 1, then ligaturing of biomedicaltissue W1 can be conducted rapidly and reliably.

Note that, in FIG. 13, the pins 97 are provided in the engaging portion96 of the distal end tube 91, however, it is also possible to provide aconcave receiving portion in the engaging portion 96, and to provide anengaging protrusion that engages with this receiving portion in the tubemain body 90. The engaging protrusion in this case can also be used as aguide member that guides the forwards or backwards movement of theneedle bodies 14.

Moreover, in this embodiment, in order to simplify the installation ofthe holding member 17 and the like, the distal end tube 91 of theovertube 7 is made freely removable from the tube main body 90 using therotating ring 101, however, other engaging devices may also be used. Forexample, as shown in FIG. 27, saw tooth shaped protrusions 120 can beprovided in a ring on an outer circumference of a base end portion ofthe distal end tube 91, and receiving portions 121 that engage with theprotrusions 120 can be provided on an inner circumferential surface of adistal end aperture of the tube main body 90. If the protrusions 120 aremanufactured using elastically deformable members, then the distal endtube 91 can be removed from or attached to the tube main body 90 simplyby pulling or pushing the distal end tube 91 in the axial direction.

Moreover, as shown in FIG. 28, it is also possible to provide acontracted diameter portion 130 at the base end portion of the distalend tube 91, and to provide a protrusion 131 at one location on theouter circumference of this contracted diameter portion 130. A portionof the distal end aperture in 90 a of the tube main body 90 is extendedin the axial direction so that an extended portion 132 is formed, and anend portion of a rubber belt 133 is fixed to this extended portion 132.An engaging member 134 is fixed to the other end portion of the rubberbelt 133. A hole 135 that engages with the protrusion 131 is provided inthe engaging member 134. As shown in FIG. 29, in a state in which thedistal end tube 91 is placed against the distal end aperture of the tubemain body 90, the rubber belt 133 is wound around the outercircumferential surface of the contracted diameter portion 130, and thehole 135 is engaged with the protrusion 131. In this case, positioningin the rotation direction of the distal end tube 91 is also possible.

Second Embodiment

A second embodiment of the present invention will be described withreference to FIGS. 30 to 33. Note that component elements that are thesame as those in the first embodiment are given the same symbols. Inaddition, any description that is duplicated from the first embodimentis omitted.

As shown in FIG. 30, a ligature and suture device for medicalapplication 201 has an operation section 202. An overtube 7 is attachedvia a tube 4 and an endoscope insertion portion 5 (see FIG. 1) to adistal end of the operation section 202.

The operation section 202 has a housing 3, and a puncture needleoperation unit 219 for a puncture needle 210 is installed in a housingportion 78 of the housing 3 so as to be able to move freely backwardsand forwards. In addition, the ligature tool operation unit 41 isinstalled in a slide receiving portion 78 so as to be able to movefreely backwards and forwards.

Here, in the puncture needle operation unit 219, a pin 223 is fixedinside an enlarged diameter portion 222 on a base end side of a puncturehandle 220. The pin 223 is placed inside a slit 34 of a pressing handle230, and is able to engage with a distal end portion 230 a of thepressing handle 230. Furthermore, the pressing handle 230 is able tomove backwards and forwards independently from the ligature tool 40.Note that the remainder of the structure of the ligature and suturedevice for medical application 201 is the same as that of the firstembodiment.

When biomedical tissue W1 is ligatured using the ligature and suturedevice for medical application 201, the biomedical tissue W1 issuctioned inside the overtube 7 inside a body cavity. Subsequently, asshown in FIG. 31, the ligature tool operation unit 41 is moved forwardsso that the ligature sheath 43 is moved forwards, and the stopper 47 isplaced adjacent to the biomedical tissue W1. As a result, the distancebetween the stopper 47 and the respective holding members 17 iscontracted.

Next, the puncture handle 220 is moved forward and the two needle bodies14 at the distal ends of each inner sheath 12 are moved forwardsimultaneously. At this time, because the pressing handle 230 is engagedby the pin 223, the pressing handle 230 moves forward together with thepuncture handle 220, and the pushers 13 also move forward the samedistance as the needle bodies 14. Because of this, the pin 223 functionsas a device for linking the pressing handle 230 while the puncturehandle 220 is moved forward from the first position to the secondposition.

Once the distal end of each needle body 14 has penetrated the biomedicaltissue W1 and arrived at the second position, the puncture handle 220 isno longer operated and the pressing handle 230 is moved forward. Asshown in FIG. 3, each pusher 13 pushes the two holding members 17 outfrom the respective needle bodies 14.

Next, after the pressing handle 230 has been returned to its initialposition, the puncture handle 230 is returned to its initial position(see FIG. 33). As a result, each pusher 13 is pulled back, and, inaddition, each pusher 13 and each needle body 14 is pulled out of thebiomedical tissue W1. Moreover, while the main body portion 50 of theligature tool operation unit 41 is in a fixed state, the ligature handle55 is moved backwards, and the ligature thread 18 is pulled by the hook45, so that the biomedical tissue W1 is sandwiched by the holdingmembers 17 and the stoppers 47 and is ligatured. After the ligaturing,the cutter handle 68 (see FIG. 24) is moved backwards, and excessligaturing thread 18 is cut.

In this embodiment, because the ligature tool 40 is provided thatoperates inside a body cavity and in the vicinity of the biomedicaltissue W1, treatment from puncturing to ligaturing can be performedrapidly. Moreover, because it is possible to move the needle bodies 14of the puncture needle 210, the pushers 13, the ligature sheath 43 ofthe ligature tool 40, and the hook 45 independently backwards andforwards, the degree of operating freedom is increased.

Third Embodiment

A third embodiment of the present invention will be described withreference to FIGS. 34 to 36. Note that component elements that are thesame as those in each of the above embodiments are given the samesymbols. In addition, any description that is duplicated from the aboveembodiments is omitted.

As shown in FIG. 34, in a ligature and suture device for medicalapplication 301 having an operation section 302, a puncture needleoperation unit 319 for a puncture needle 310 is inserted in a housingportion 70 of a housing 3. The puncture needle operation unit 319 isprovided with a linking pin 23 that engages and links the puncturehandle 20 with a pressing handle 330, however, the pressing handle 330and the ligature tool 40 are able to move backwards and forwardsindependently. Note that, in FIG. 34, a state is shown in which theligature tool 40 is pressed in by a predetermined amount. The remainingcomponent elements of the ligature and suture device for medicalapplication 301 are the same as those in the first embodiment.

When biomedical tissue W1 is ligatured using the ligature and suturedevice for medical application 301, the biomedical tissue W1 issuctioned inside the overtube 7 inside a body cavity. Subsequently, theligature tool 40 is moved forwards so that the stopper 47 is movedforwards to a position near the side aperture 95 on the distal end sideof the needle bodies 14.

Next, the pressing handle 330 is moved forward. Because the puncturehandle 20 is linked to the pressing handle 330 by the linking pin 23,the respective needle bodies 14 are moved forward towards the biomedicaltissue W1 together with the respective pushers 13. As shown in FIG. 35,when the respective needle bodies 14 arrive at the second position wherethey penetrate the biomedical tissue W1, because the linking pin 23 ismoved so that the link between the pressing handle 330 and the puncturehandle 20 is released, subsequently only the pressing handle 330 ismoved forward. Next, as shown in FIG. 36, at the farthest forwardposition of the pressing handle 330, the respective pushers 13 push therespective holding members 17 out from the respective needle bodies 14.Note that, during this time, the ligature tool 40 is in a stopped state.

After this, if the pressing handle 330 is pulled back, only the pressinghandle 330 moves backwards as far as the second position where thelinking pin 23 once again operates, and once the pressing handle 330passes the second position, the puncture handle 20 also moves backwardsin conjunction with the pressing handle 330. In this manner, once eachneedle body 14 has been pulled out and the ligature thread 18 has beenmade to penetrate the biomedical tissue W1, the ligature handle 55 ismoved backwards, the biomedical tissue W1 is ligatured, and excessligature thread is cut using the cutter handle 68 (see FIG. 24).

In this embodiment, because the ligature tool 40 is provided thatoperates inside a body cavity and in the vicinity of the biomedicaltissue W1, treatment from puncturing to ligaturing can be performedrapidly. Moreover, because the needle bodies 14 of the puncture needle310 and, the pushers 13 are linked together when the biomedical tissueW1 is punctured and when the needle bodies 14 are removed from thebiomedical tissue W1, the actions during this time can be performed in asingle operation, so that operability is improved.

Fourth Embodiment

A fourth embodiment of the present invention will be described withreference to FIGS. 37 to 41. Note that component elements that are thesame as those in each of the above embodiments are given the samesymbols. In addition, any description that is duplicated from the aboveembodiments is omitted.

As shown in FIG. 37, in a ligature and suture device for medicalapplication 401 having an operation section 402, a puncture needleoperation unit 419 for a puncture needle 410 is inserted in a housingportion 70 of a housing 3. In the puncture needle operation unit 419, apuncture handle 420 and a pressing handle 430 are able to move backwardsand forwards independently. In addition, a linking device 460 that linksthe puncture handle 420 with a ligature tool 440 is provided. Thelinking device 460 is formed by an engaging claw 462 that extends in thedistal end direction from a top portion of a supporting portion 461 thatis attached to an enlarged diameter portion 222 of the puncture handle420, and by an engaged portion 463 that extends downwards from a fingerpiece portion 452 of a ligature tool operation unit 441. As shown inFIG. 38, two of the engaging claws 462 are provided parallel with eachother. Each of these can be elastically deformed, and distal endsthereof are bent so as to approach each other. The engaged portion 463has a width and length that enables it to be engaged with the engagingclaws 462.

The remaining component elements of the ligature and suture device formedical application 401 are the same as those in the first embodiment.

In this ligature and suture device for medical application 401, in aninitial state, the puncture handle 420 is pulled out such that theengaging claw 462 is on the rear side of the engaged portion 463 of theligature tool 440. If the puncture handle 420 is moved forward, thepressing handle 430 also moves forward in conjunction with this, sothat, as a result, the needle bodies 14 and the pushers 13 move forwardssimultaneously. Here, as shown in FIG. 39 and FIG. 40, once the puncturehandle 420 has moved forward a predetermined length, the engaging claw462 engages with the engaged portion 463, so that the puncture handle420 and the ligature tool 440 are linked together. This predeterminedlength is a distance such that excess tensile force does not act on theligature thread 18 between the holding members 17 inside the needlebodies 14 and the stopper 47.

When the puncture handle 420 is moved even further forward, therespective needle bodies 14, the respective pushers 13, the ligaturetool 440, and the cutter 60 (see FIG. 1) are moved forwardssimultaneously. As shown in FIG. 41, at the position where the puncturehandle 420 comes up against the housing portion 70, each of the needlebodies 14 has penetrated the biomedical tissue W1. After this, if thepressing handle 430 is moved forward, only the respective pushers 13 aremoved forward and the respective holding members 17 are pushed out.

Next, the pressing handle 330 is returned. Furthermore, after theconnection between the puncture handle 420 and the ligature tool 440 isbroken, the puncture handle 420 is pulled back, and the respectiveneedle bodies 14 are removed from the biomedical tissue W1. The ligaturehandle 55 is further pulled so that the biomedical tissue W1 isligatured and excess ligature thread 18 is cut by the cutter portion 62(see FIG. 24).

In this embodiment, because the ligature tool 440 is provided thatoperates inside a body cavity and in the vicinity of the biomedicaltissue W1, treatment from puncturing to ligaturing can be performedrapidly. Moreover, by using the linking device 460, the puncture handle420 and the ligature tool 440 can be simply and reliably linked.Accordingly, when puncturing the biomedical tissue W1, by operating thepuncture handle 420, the needle bodies 14, the pushers 13, the ligaturetool 440, and the cutter portion 62 can be moved together. Therefore,the actions during this time can be performed in a single operation, sothat operability is improved.

Furthermore, if a puncture is made in error and the needle bodies 14 areremoved and the puncture is made again, because it is possible to movethe ligature tool 440 backwards and forwards simply by operating thepuncture handle 420, the operation is made easy.

Fifth Embodiment

A fifth embodiment of the present invention will be described withreference to FIGS. 42 to 44. Note that component elements that are thesame as those in each of the above embodiments are given the samesymbols. In addition, any description that is duplicated from the aboveembodiments is omitted.

As shown in FIG. 42, a ligature and suture device for medicalapplication 501 has an operation section 502, and is further providedwith a linking device 560 that links a pressing handle 530 with theligature tool 440. The linking device 560 is formed by the engaging claw462 and the supporting portion 461 thereof that are provided in thepressing handle 530, and by the engaged portion 463 that is provided inthe finger piece portion 452 of the ligature tool operation unit 441.The remaining component elements are the same as those in the fifthembodiment

In this ligature and suture device for medical application 501, bymoving the puncture handle 220 forward, the pressing handle 530 isdriven subordinately and the respective needle bodies 14 and respectivepushers 13 are moved forward. At this time, before the puncture handle220 is housed in the housing portion 70, as shown in FIG. 43, thepressing handle 530 and the ligature tool 440 are engaged by the linkingdevice 560, and begin to move together. Moreover, as shown in FIG. 44,if the puncture handle 220 is moved forward as far as the thirdposition, then the respective holding members 17 are pushed out from therespective needle bodies 14, and the stopper 47 is moved forward to aposition adjacent to the biomedical tissue W1.

In this embodiment, because the ligature tool 440 is provided thatoperates inside a body cavity and in the vicinity of the biomedicaltissue W1, treatment from puncturing to ligaturing can be performedrapidly. Moreover, by using the linking device 560, the pressing handle430 and the ligature tool 440 can be simply and reliably linked.Accordingly, when puncturing the biomedical tissue W1, by operating thepuncture handle 220, the needle bodies 14, the pushers 13, the ligaturetool 440, and the cutter portion 62 can be moved together. Therefore,the actions during this time can be performed in a single operation, sothat operability is improved.

Sixth Embodiment

A sixth embodiment of the present invention will be described withreference to FIGS. 45 to 50. Note that component elements that are thesame as those in each of the above embodiments are given the samesymbols. In addition, any description that is duplicated from the aboveembodiments is omitted.

As shown in FIG. 45, a ligature and suture device for medicalapplication 601 has an operation section 602, and is further providedwith the linking device 560 that connects the pressing handle 530 andthe ligature tool 440. The remaining component elements are the same asthose in the first embodiment.

In this ligature and suture device for medical application 601, in aninitial state, the pressing handle 530 is pulled out to the firstposition, and the pressing handle 530 and the puncture handle 20 arelinked by the linking pin 23. In addition, the engaged portion 463 ofthe ligature tool 440 is positioned closer to the distal end side thanthe engaging claw 462 of the pressing handle 530, so that both areindependent of each other.

When ligaturing the biomedical tissue W1, firstly, the pressing handle530 is moved forward. The puncture handle 20 moves forwarded inconjunction with the pressing handle 530, and the respective needlebodies 14 and the respective pushers 13 move forward. Furthermore, ifthe pressing handle 530 is pressed, the engaging claw 462 and theengaged portion 463 are engaged in a predetermined position, so that theligature tool 440 is linked to the pressing handle 530. The distance ofthe movement of the pressing handle 530 from its initial position untilit is linked to the puncture handle 20 is set within a range such thatexcess tensile force does not act on the ligature thread 18 between therespective holding members 17 and the stopper 47.

Moreover, as shown in FIG. 46, when the linking pin 23 of a punctureneedle operation unit 619 is housed inside the housing portion 70 at thesecond position, the engagement between the pressing handle 530 and thepuncture handle 20 is released. At this time, the respective needlebodies 14 have penetrated the biomedical tissue W1.

If the pressing handle 530 is moved forward even further, the ligaturetool 440 moves forward in accordance with this. As shown in FIG. 47,when the engaged portion 463 comes against the base end surface of thehousing portion 70, the respective pushers 13 push the respectiveholding members 17 out from the respective needle bodies 14.

Next, the pressing handle 530 is pulled backwards while releasing theengagement between the engaged portion 463 and the engaging claw 462. Inthe same way as in the first embodiment, after only the respectivepushers 13 have moved backwards, the pressing handle 530 and thepuncture handle 20 begin to move together, and the respective pushers 13and the respective needle bodies 14 are removed from the biomedicaltissue W1. By further operating the ligature tool 440 and the cutter 60(see FIG. 24), the biomedical tissue W1 is ligatured and excess ligaturethread 18 is cut.

In this embodiment, the same effects as those of the first embodimentare obtained. Furthermore, because the linking device 560 is provided,and the ligature tool 440 and the pressing handle 530 are linked, it ispossible to move the needle bodies 14 backwards and forwards integrallywith the ligature tool 440. Accordingly, for example, when installingthe holding members 17 or the like, or when confirming the punctureposition, a forwards or backwards movement can be easily performed.

Here, as shown in FIG. 48 through FIG. 50, in the ligature and suturedevice for medical application 601, at least one of the puncture handle20, the pressing handle 530, and the ligature tool 440 can be movedindependently backwards or forwards.

Namely, in FIG. 48, only the ligature tool 440 is moved independentlyforward, and the stopper 47 is moved beforehand towards the sideaperture 95.

In FIG. 49, in a state in which the linking device 560 is not operated,the puncture handle 20 is moved forward and only the needle bodies 14are moved forward.

In FIG. 50, in a state in which the linking device 560 is not operated,only the pressing handle 530 is moved forward, and only the pushers 13are moved forward so that the holding members 17 are discharged from theneedle bodies 14. This type of operation is performed, for example, whenreplacing holding members 17 or when checking an operation.

Note that the present invention is not limited to the above describedembodiments and may be used in a wide variety of applications.

For example, the puncture needles 10, 210, 310, and 410 may have onlyone needle body 14.

Each of the ligature and suture devices for medical application 1, 201,301, 401, 501, and 601 may also not be provided with the cutter 60.Namely, it is also possible for the stopper 47 to collide directly withthe distal end of the ligature sheath 43. In this case, as shown in FIG.51, excess ligature thread is cut using forceps 6 a that have beeninserted into a channel in the endoscope 6. At this time, if theligature handle 55 is slightly pressed in and the hook 45 moved forward,then the ligature thread 18 is slackened off and can easily be cut. Asshown in FIG. 52, after the ligature thread 18 has been cut, then afterthe forceps 6 a (see FIG. 49) have been housed inside the endoscope 6,the suctioning of the biomedical tissue W1 is stopped, and the overtube7 is pulled out.

Moreover, in each of the ligature and suture devices for medicalapplication 1, 201, 301, 401, 501, and 601, it is also possible for therespective ligature tools 40 and 440 to be ligature tools that areprovided with the cutter 60.

In a ligature and suture device for medical application 701 such as thatshown in FIG. 53, a slide member 702 is inserted in the slide receivingportion 78 so as be able to slide freely therein, and the ligature tool40 is fixed to a top portion of the slide member 702. In this ligatureand suture device for medical application 701, apart from the ligaturetool 40 being on a separate axis, the remainder of the structure is thesame as the ligature and suture device for medical application 701 shownin FIG. 1.

Moreover, as is the case with the ligature and suture device for medicalapplication 801 shown in FIG. 54, it is also possible to employ astructure in which the slide member 702 can be freely attached to andremoved from the housing 3. In this type of ligature and suture devicefor medical application 801 replacing the ligature tool 40 is simple.The remainder of the structure is the same as that of the ligature andsuture device for medical application 701.

Moreover, it is also possible to manufacture an overtube 7 such as thatshown in FIG. 1 from a colorless material so as to provide a mark on theouter circumferential surface thereof that enables the positions of thebiomedical tissue W1 being ligatured and of the side aperture 95 to beverified. For example, a mark 900 shown in FIG. 55 is provided on anouter circumferential surface of the distal end tube 91, running alongthe peripheral edge portion of the side aperture 95. In addition, insidethe peripheral edge portions, toroidal portions 900 a and 900 b areprovided extending in the circumferential direction respectively at theedge portion on the distal end side and the edge portion on the base endside. The mark 900 may be colored green, for example, in order to makeit easy to distinguish it from surrounding tissue. Furthermore, as shownin FIG. 56, a cruciform mark 901 whose cross is formed running in thelongitudinal direction and the circumferential direction of the distalend tube 91 is provided at a position whose phase is shifted 180 degreesfrom the side aperture 95. A portion 902 where the cross intersects inthe mark 901 is a position whose phase is shifted 180 degrees relativeto the center of the side aperture 95. As shown in FIG. 53, an endportion 901 a of the portion that extends in the circumferentialdirection extends to the peripheral edge portion of the side aperture95. In addition, as shown in FIG. 56, a distal end 903 and a base end of904 of the portion that extends in the longitudinal direction extendrespectively beyond the toroidal portion 900 a and the toroidal portion900 b of the mark 900. This type of mark 901 may, for example, becolored blue. As shown in FIG. 57, the marks 900 and 901 are used inorder to confirm the positions of the side aperture 95 and thebiomedical tissue W1 using the endoscope 6 inside the body cavity.Namely, the overtube 7 is inserted via the esophagus W2 to a top portionof a stomach W3 and the endoscope 6 is made to protrude from the distalend thereof. The endoscope 6 is then bent such that the marks 900 and901 appear in the field of vision shown virtually in the drawing. Byobserving the positions of the portions 900 a and 900 b of the mark 900,the positions of the biomedical tissue W1 and the side aperture 95 canbe adjusted in the forwards and backwards direction of the overtube 7,and the position in the rotation direction of the side aperture 95 canbe adjusted by observing the position of the intersection portion 902 ofthe mark 901.

Here, as shown in FIG. 56, it is possible to also provide a mark 910 onthe tube main body 90 side. When the placements of the side aperture 95and needle bodies 14 are at positions suitable for ligaturing, the mark910 is provided at a position that is aligned in a straight line withthe other end 904 of the mark 901. Namely, if the distal end tube 91such as that shown in FIG. 27 and the like is able to be rotated, thenif the distal end tube 91 is positioned such that the mark 901 and themark 910 are aligned rectilinearly, then the rotation position of thedistal end tube 91 can be set to the optimum position.

The ligature and suture device for medical application according to thepresent invention is used to ligature biomedical tissue inside a bodycavity. A needle body that houses a holding member is made to penetratebiomedical tissue from one side portion thereof to the other sideportion thereof and the holding member is pushed out to the other sideportion side. A ligature member is attached to the holding member, andwhen the needle body is withdrawn from the biomedical tissue thisligature member is left penetrating the interior of the biomedicaltissue from one side portion thereof to the other side portion thereof.Furthermore, a stopper is provided on one side portion side of theligature member. As a result, if the ligaturing is conducted such thatthe biomedical tissue is sandwiched by the stopper and the holdingmember, this portion can be made to bulge out.

At this time, because the puncture handle that moves the needle bodybackwards and forwards, the pressing handle that moves the pressingmember, which pushes out the holding member, backwards and forwards, andthe ligature tool operation unit and ligature handle that are operatedwhen ligaturing is being performed are provided so as to be able to movefreely backwards and forwards inside the housing, it is possible for aprocedure from the puncturing by a puncture needle to the ligaturing tobe performed by an operation on the operator side.

In the above ligature and suture device for medical application, theoperation section may have a linking device that links the puncturehandle with the pressing handle.

In this ligature and suture device for medical application, when thepressing handle is driven, because the puncture handle is also moved inconjunction with the pressing handle due to the linking device, it ispossible to move the pressing member in conjunction with the needlebody. Note that when the puncture handle is driven, it is also possiblefor the pressing handle to be moved in conjunction with the puncturehandle.

In the above ligature and suture device for medical application, theoperation section may have a linking device that links the ligature tooloperation unit with the pressing handle.

In this ligature and suture device for medical application, when thepressing handle is driven, because the ligature tool operation unit isalso moved in conjunction with the pressing handle due to the linkingdevice, it is possible to move the pressing member in conjunction withthe stopper. As a result, is possible to prevent tensile force fromacting on the ligature member. Note that when the ligature tooloperation unit is driven, it is also possible for the pressing handle tobe moved in conjunction with the ligature tool operation unit.

In the above ligature and suture device for medical application, theoperation section may have a linking device that links the ligature tooloperation unit with the puncture handle.

In this ligature and suture device for medical application, when thepuncture handle is driven, because the ligature tool operation unit isalso moved in conjunction with the puncture handle due to the linkingdevice, it is possible to move the needle body in conjunction with thestopper. Note that when the ligature tool operation unit is driven, itis also possible for the puncture handle to be moved in conjunction withthe ligature tool operation unit.

In the above ligature and suture device for medical application, theoperation section may have a linking device that links the puncturehandle with the pressing handle and the ligature tool operation unit.

This ligature and suture device for medical application has a linkingdevice, and when the puncture handle is driven, the pressing handle andthe ligature tool operation unit are moved in conjunction with thepuncture handle. As a result, the pressing member and the stopper aremoved in conjunction with the movement of the needle body. Note that, itis also possible for the puncture handle and the ligature tool operationunit to be moved in conjunction with the driving of the pressing handle,and it is also possible for the puncture handle and the pressing handleto be moved in conjunction with the driving of the ligature tooloperation unit.

According to another ligature and suture device for medical applicationof the present invention, because the puncture handle is moved inconjunction with the pressing handle during the time that the puncturehandle is moved from a first position to a second position and thebiomedical tissue is penetrated by the needle body, it is possible tomove the needle body and the pressing member forward together.Furthermore, the pressing handle and the ligature tool operation unitare moved together during the time that the puncture handle is moving tothe second position. As a result, for example, by operating the pressinghandle, it is possible to indirectly operate the puncture handle and theligature tool operation unit. Namely, simply by conducting an operationin one location, it is possible to operate the ligature and suturedevice for medical application, and, moreover, the positions of eachportion can be controlled appropriately to match the stage of treatment.

In the above ligature and suture device for medical application, thesecond linking device may push the pressing handle forward beyond thetissue puncture state, and the ligature tool operation unit may be movedforward interconnectedly with the pressing handle until the holdingmember is pushed out from the needle body.

In this ligature and suture device for medical application, when theholding member is pushed out from the needle body, the ligature tooloperation unit moves forward in conjunction with the pressing member andthe stopper also moves forward.

In the above ligature and suture device for medical application, thesecond linking device may be a device that moves the pressing handle andthe ligature tool operation unit forwards and backwards independentlyrelative to the direction in which the pressing handle moves backwards.

In this ligature and suture device for medical application, a structureis employed in which, when the pressing handle is moved backwards, theligature tool operation unit does not move backwards in conjunction withthe pressing handle.

The ligaturing and suturing method for medical application of thepresent invention is a method of ligaturing biomedical tissue inside abody cavity. By causing a needle body housing a holding member topenetrate the biomedical tissue from a base end side thereof to a distalend side thereof, after the holding member has been left behind at thedistal end side and the needle body has been removed, the biomedicaltissue is ligatured by sandwiching the biomedical tissue between thestopper on the base end side and the holding member, and this portioncan be made to bulge out.

In the above ligature and suture method for medical application, theremay be provided a step in which, after the needle body has punctured thebiomedical tissue, the stopper is moved forward in conjunction with theforward movement of the pressing member.

In this ligaturing and suturing method for medical application, bymoving the pressing member forward in conjunction with the stopper, itis possible to prevent excess tensile force from acting on the ligaturemember between the holding member and the stopper.

In the above ligature and suture method for medical application, theremay be provided a step in which, when the needle body is being removedfrom the biomedical tissue, the needle body is moved backward inconjunction with the backward movement of the pressing member.

In this ligaturing and suturing method for medical application, bymoving the needle body backwards in conjunction with the backwardmovement of the pressing member, it is possible to prevent the pressingmember from being left behind inside the biomedical tissue.

In the above ligature and suture method for medical application, whenthe needle body is being removed from the biomedical tissue, the needlebody may be moved backwards independently from the stopper.

In this ligaturing and suturing method for medical application, astructure is employed in which, when the needle body and the pressingmember are moved backwards in conjunction with each other, the stopperdoes not move backwards in conjunction with the needle body and thepressing member. As a result, ligaturing after the needle body has beenremoved is simplified.

According to the present invention, when ligaturing is performed bycausing a ligature member to penetrate biomedical tissue, because thedevice used for the ligaturing is operated by an operation section,treatment is simplified. In addition, because the operation section isformed as a single body when in use, handling is simplified.Furthermore, if a structure is employed in which any two or more of theneedle body, the pressing member, and the ligature tool operation unitare operated in conjunction, the operation in the operation section issimplified.

(Additional Item 1)

In the aforementioned ligature and suture device for medicalapplication, in the operation section, the puncture handle and thepressing handle may be provided such that they can be freely attached toor removed from the housing.

In this ligature and suture device for medical application, by removingthe puncture handle and pressing handle from the housing, replacement ofthe puncture needles is possible.

(Additional Item 2)

In the aforementioned ligature and suture device for medicalapplication, in the operation section, the ligature tool may be providedsuch that it can be freely attached to or removed from the housing.

In this ligature and suture device for medical application, by removingthe ligature tool from the housing, replacement of components associatedwith ligature is possible.

1. A ligature and suture device for medical application, comprising: adistal end insertion portion that is inserted into a body cavity and inwhich at least one side aperture is provided; a needle body that isprovided inside the distal end insertion portion, and that houses insideitself a holding member that is attached to an end portion of a ligaturemember that is inserted into biomedical tissue, and in which a pressingmember that presses the holding member is inserted so as to move freelybackwards and forwards, and that punctures biomedical tissue that hasbeen made to bulge into the distal end insertion portion via the sideaperture; a ligature tool that has a flexible ligature sheath thatpresses a stopper that is penetrated by the ligature member towards thebiomedical tissue and hold the biomedical tissue between holding memberand the stopper, and that, at a distal end of an operating wire that hasbeen inserted into the ligature sheath so as to move freely backwardsand forwards, is provided with an engaging portion that engages with theligature member that has been inserted into the stopper; and anoperation section that is provided at a base end side of the distal endinsertion portion, wherein the operation section comprises: a housingthat is provided in a base end portion of the distal end insertionportion; a puncture handle that is provided in the housing so as to movefreely backwards and forwards and that drives the needle body; apressing handle that is provided in the housing so as to move freelybackwards and forwards and that drives the pressing member; a ligaturetool operation unit that is provided in the housing so as to move freelybackwards and forwards and that drives the ligature sheath; and aligature handle that is provided in the ligature tool operation unit soas to move freely backwards and forwards and that drives the engagingportion.
 2. The ligature and suture device for medical applicationaccording to claim 1, wherein the operation section has a linking devicethat links the puncture handle with the pressing handle.
 3. The ligatureand suture device for medical application according to claim 1, whereinthe operation section has a linking device that links the ligature tooloperation unit with the pressing handle.
 4. The ligature and suturedevice for medical application according to claim 1, wherein theoperation section has a linking device that links the ligature tooloperation unit with the puncture handle.
 5. The ligature and suturedevice for medical application according to claim 1, wherein theoperation section has a linking device that links the puncture handlewith the pressing handle and the ligature tool operation unit.